Rhabdomyolysis

By ac

*I apologize for the superscripts!  They did not format correctly when pasting the blog from a Google doc.

We have been receiving a lot of questions about Rhabdomyolysis (Rhabdo) the last few days after the article, “Crossfit’s Dirty Little Secret” http://www.huffingtonpost.com/eric-robertson/crossfit-rhabdomyolysis_b_3977598.html, went viral on Facebook and then reported on the Good Morning America show.  Hopefully, people are also reading the articles in support of our sport like this one, https://medium.com/i-m-h-o/6d606a0b7d31 .  I hope this post will help answer some questions and ease some fears.

 

I’m sure a lot of you have reached to the internet to self educate yourselves on what Rhabdo is.  In case you have not, here is a summary of the condition.  Rhabdo occurs when a large amount of skeletal muscle breakdown occurs in the body.  The inner contents of the muscle cells begin to pour out into surrounding tissues.  Potassium, which is normally in high concentration inside muscles, pours out of the muscles into the blood and surrounding tissue spaces, and sodium and calcium tend to flow inward, building up inside the cells. 1   Normally the excess potassium in the blood is filtered out by the kidneys, but in this instance there is also an excess of myoglobin (an iron- and oxygen-binding protein) in the blood due to the high amount of muscle breakdown.  In the kidneys, myoglobin breaks down into a toxic chemical called ferrihaemate, which damages the kidneys so they cannot properly filter the excess potassium.1 The result can be partial to complete kidney failure, hyperkalemia (elevated potassium in the blood), hyponatremia (low sodium ion concentration), hypocalcemia (low blood calcium levels) and hypovolemia (decreased blood volume).2   Rhabdomyolysis can also cause extreme muscle soreness and compartment syndrome in skeletal muscle due to the increased accumulation of liquid. 

Who can get Rhabdo?  Anyone can get it.  It is not limited to athletes, nor is it most commonly seen in athletes.  The greatest cause for Rhabdo is alcohol abuse.3 After alcohol abuse the most common risk factors are muscle overexertion, muscle compression and use of certain medications and drugs.3  Since we are most concerned with muscle overexertion let’s look at which athletes are most prone to this condition.

Rhabdomyolysis has been reported mostly in long distance runners, triathletes, football players, cross country skiiers and “weekend warriors”.4  There is even a study published about two well conditioned athletes who were diagnosed with Rhabdo after an all night session of bongo drum playing!5  It can occur in novice and well conditioned athletes.  Rhabdo appears to occur more frequently in sports that require a large volume of eccentric contractions (contractions in which the muscles attempt to shorten while they are being stretched).  Running, squatting, jumping, climbing and some gymnastics movements involve a lot of eccentric contractions. 

No one knows exactly why some people get Rhabdo and others do not.  There may be some traits that make people more susceptible to the condition than others.3  Overall, Rhabdo is a rare condition.  Mild cases are much more common than ones that require treatment.4

The most common symptoms of rhabdomyolysis include muscle pain, stiffness and extreme weakness. Altered mental status can also occur.1,2  Symptoms may not be present until 5-24 hours after exertion and some people will have no symptoms at all until they suddenly feel ill.
    
In CrossFit we do a lot of eccentric movements.  These movements are of great benefit to the building of our strength.  They are not dangerous when done properly.  As an athlete you have the responsibility to take care of yourself and to listen to your body.  Taking certain precautions such as, making sure you are hydrated before exercise, limiting alcohol consumption the day before strenuous exercise and cutting the intensity back on hot and humid days, can prevent rhabdomyolysis from ever occurring.  You also need to listen to your body and listen to your coach.  Coaches are trained to observe you during class and watch for any signs of overexertion.  If they tell you to scale down (reps, weight rounds, etc.) then do it.  Coaches are also trained to push you to work hard.  If you have a coach in your face, but your body is not “feeling it” that day, then let the coach know.  “Use your words” as I say to my five-year-old!  Coaches are not mind readers.  You need to let your coach know if you are not feeling your best on any given day. 

We do CrossFit because we love the intensity and difficulty of the workouts.  We all want to work our hardest and finish each and every wod.  This is great, but…
Take the time to check in with yourself from time to time.  If the wod is intense and you are struggling, but you are really okay, then keep going for it!  If you start feeling lightheaded, chills, dry in the mouth, unable to focus, then it’s time to cut it back.  Use common sense.  There will always be another wod you can crush as long as you are healthy!

1. Bledsoe, Jim. “Rhabdomyolysis”. Sports Injury Bulletin. Web. 26 September, 2013. <www.sportsinjurybulletin.com/archive/rhabdomyolysis.html>

2. Wright, Will, M.D.  “Rhabdomyolysis Revisited”. Crossfit Journal.  June, 2011.  Web.  26, September, 2013. <http://library.crossfit.com/free/pdf/CFJ_Wright_Rhabdo.pdf>

3. Sauret, John, Marinides, George, M.D. and Gordon Wang, M.D.  “Rhabdomyolysis”.  Pub Med.  March, 2002. Web. 26 September, 2013.  <http://www.ncbi.nlm.nih.gov/pubmed/11898964>

4. Line, Robert M.D. and George S. Rust M.D. “Acute Exertional Rhabdomyolysis”.  Dr. Place.  August, 1995.  Web.  26, September, 2013.  <http://www.drplace.com/Acute_exertional_rhabdomyolysis.16.21440.htm>

5.  Hurley, JK.  “Severe Rhabdomyolysis in Well Conditioned Athletes”.  Pub Med.  May, 1998.  Web.  26 September, 2013.  <http://www.ncbi.nlm.nih.gov/pubmed/2499838>

Other reading if interested…

http://archinte.jamanetwork.com/article.aspx?articleid=600582

http://www.sciencedirect.com/science/article/pii/0022510X83900370

http://www.ncbi.nlm.nih.gov/pubmed/11898964

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